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OCR for page 405
APPENDIX
A
The Committee's Recommendations
MONITORING THE EPIDEMIC'S COURSE
The committee recommends that an appropriate federal agency
mount a continuing program to monitor HIV testing at all labo-
ratories doing such testing.
The committee recommends that CDC and other agencies with
HIV/AIDS data gathering and reporting functions review their data
disclosure practices, searching for rules and setting policies that con-
tinue to safeguard confidentiality but do so at the least practical cost
in information.
The committee recommends that efforts be made to reformulate the
CDC family of seroprevalence surveys as probability samples.
The committee recommends instituting a continuing anonymous
probability survey of the HIV serostatus of women who are clients of
clinics that provide abortion services.
The committee recommencis that the newborn infant seroprevaTence
survey be extended to include all children born in the United States.
HUMAN SEXUAL BEHAVIOR AND AIDS
The committee recommends that the Public Health Service support
vigorous programs of basic social and behavioral research on human
sexual behavior, particularly through such agencies as the National
405
OCR for page 406
406 ~ APPENDIX A
Institutes of Health; the Alcohol, Drug Abuse, and Mental Health
Administration; and the Centers for Disease Control.
The committee recommends that ciata be collected to estimate the
prevalence of the sexual risk-taking behaviors associated with the
acquisition and spread of HIV infection in various populations, in-
cluding those at higher and lower risk.
The committee recommends that funding be provided (and contin-
ued over time) to support prospective longitudinal studies of sexual
behavior, and that high priority be given to studies of the social and
societal contexts of sexual behaviors.
The committee recommends that the Public Health Service support
research in those subsets of the population that are at increased risk
of HIV infection.
The committee recommends immediate steps to close the vast gaps
in our knowledge of the relationship of sexual behavior and drug and
alcohol use.
The committee recommencis that resources be invested in method-
ological research to develop better procedures to obtain information
from hard-to-reach groups.
The committee recommends that an indepenclent review of STD ciata
collection systems be undertaken and sufficient resources provicled to
undertake any improvements that may be required.
The committee recommends that the Public Health Service immedi-
ately begin a research program to determine the extent to which the
use of condoms and spermicides reduces the risk of HIV transmission.
This program should inclucle investigations of the current use of these
products, how that use might be modified, and equally important—
how these products themselves may be modified to encourage uses
compatible with human skills and dispositions.
The committee recommencis a concerted effort to upgrade and stan-
dardize (when possible and clesirable) the procedures used to gather
behavioral data in clinical and biomedical research settings.
The committee recommends that funcling agencies, both public and
private, encourage the sharing of data relevant to HIV infection and
AIDS that have been gathered by federal and extramural researchers,
OCR for page 407
APPENDIX A ~ 407
within the limits set by scientific priority ant! confidentiality. To fa-
cilitate such sharing, the committee recommends that a data archive
be established to support secondary analyses of these data.
The committee recommends that local public health authorities en-
sure that treatment for all sexually transmitted diseases is readily
available to all persons who may seek such treatment.
The committee recommends that local public health authorities en-
sure that condoms are readily available to all sexually active persons.
AIDS AND IV DRUG USE
The committee recommends that well-clesigned, staged trials of ster-
ile needle programs, such as those requested in the 1986 Institute of
Medicine/National Academy of Sciences report Confronting AIDS,
be implemented.)
The committee recommends that high priority be given to studies
of the social and societal contexts of IV drug use and IV drug-use
prevention efforts.
The committee recommends that high priority be given to research on
the natural history of IV drug use, with an emphasis on prospective
longitudinal studies of the factors associated with initiation into and
cessation of {V drug use.
The committee recommends that high priority be given to studies
of the sexual and procreative behavior of IV drug users, including
methods to reduce sexual and perinatal (mother-infant) transmission
of HIV.
The committee recommends that the appropriate government au-
thorities take immediate action to (1) provide drug treatment upon
request for IV drug users throughout the country; (2) sustain and
expand current programs that provide for "safer injection" to reach
all current IV drug users in the nation on a continuing basis and
with appropriate research evaluation; and (3) establish data collec-
tion systems for monitoring present AIDS prevention efforts for {V
drug users.
fin the text of the report, this recommendation appears in Chapter 4.
OCR for page 408
408 ~ APPENDIX A
The committee recommends that high priority be given to research
that will lead to improved drug-use treatment, including studies of
relapse prevention and of treatment for cocaine dependence. Ap-
plied research should include planned variation and evaluation of
experimental programs.
The committee recommends that high priority be given to studies
of IV drug users who are not in contact with health care, drug-use
treatment, or criminal justice systems.
The committee recommends that high priority be given to method-
ological studies to determine ways of improving the quality of self-
reports of sexual and drug-use behavior.
The committee recommends that high priority be given to research
on the estimation of the current number of IV drug users in the
United States and of seroprevalence rates among different groups of
IV drug users.
FACILITATING CHANGE IN HEALTH BEHAVIORS
The committee recommends making information available in clear,
explicit language in the idiom of the target audience.
The committee recommends that AIDS prevention messages strike a
balance in the level of threat that is conveyed.
The committee recommends that television networks present more
public service messages on those behaviors associated with HIV
transmission and practical measures for interrupting the spread of
infection.
The committee recommends that television networks accept condom
advertisements.
The committee recommends that programs to initiate and sustain
changes in risk-associated behavior take into account how the tar-
geted population perceives and understands risk.
.
The committee recommends that innovative approaches to AIDS
prevention programs be introduced in a planned manner that reflects
well-established principles about the adoption and diffusion of new
ideas.
OCR for page 409
APPENDIX A | 409
The committee recommends that programs to facilitate behavioral
change be approached as long-term efforts, with multiple and re-
peated strategies to initiate and sustain behavioral change over time.
The committee recommends that anonymous HIV antibody testing
with appropriate pre- and posttest counseling be made available on
a voluntary basis for anyone desiring it.
The committee recommends that programs consider the psychologi-
cal, social, biological, and environmental factors that may affect re-
lapse; learned coping responses, including skills training anct relapse
rehearsal, should be taught to increase perceptions of self-efficacy.
The committee recommends that, to the extent possible, community-
level interventions to prevent the spread of HIV infection address
simultaneously information, motivational factors, skills, prevailing
norms, and methods for diffusing innovation.
The committee recommends that sex education be available to both
mate and female students and that such education inclucle explicit
information relevant to the prevention of HIV infection.
The committee recommends that planned variations of key program
elements be systematically and actively incorporated into the design
of intervention programs at an early stage.
The committee recommends that the Public Health Service and oth-
ers conducting or supporting intervention programs ensure the im-
plementation of planned variations in AIDS messages? programs, and
.
campaigns.
EVALUATING THE EFFECTS OF AIDS
INTERVENTIONS
The committee recommends that the Office of the Assistant Secretary
for Health take responsibility for an evaluation strategy that will
provide timely information on the relative effectiveness of different
AIDS intervention programs.
The committee recommends the expanded use of randomized field
experiments for evaluating new intervention programs on both indi-
vidual and community levels.
OCR for page 410
410 ~ APPENDIX A
The committee recommends that evaluation support be provided
to ensure collaboration between practitioners and evaluation re-
searchers.
The committee recommends to the research community that the
results of well-conducted evaluations be published, regardless of the
intervention's effectiveness.
The committee recommends that all evaluations publish detailed
descriptive information on the nature and methods of intervention
programs, along with evaluation data to support claims of relative
effectiveness.
The committee recommends that only the best-designed and best-
implemented intervention programs be selected to receive those spe-
cial resources that will be needed to conduct scientific evaluations.
The committee recommencis that CDC substantially increase efforts,
with links to extramural scientific resources, to assist health depart-
ments and others in mounting evaluations.
BARRIERS TO RESEARCH
The committee recommends that serious consideration be given to
exempting research on HIV infection and AIDS from the require-
ments of the Paperwork Reduction Act.
The committee recommends that intervention programs at all levels
increase the involvement of minority researchers and minority health
care workers to assist in reaching and involving the black, Hispanic,
and gay communities.
The committee recommends that support of multidisciplinary cen-
ters for research on AIDS prevention be viewed as a long-term com-
mitment to allow sustained collaborative efforts, including valuable
prospective studies.
The committee recommends that the number of trained behavioral
and social scientists employed in AIDS-related activities at federal
agencies responsible for preventing the spread of HIV infection be
substantially increasecl.
OCR for page 411
APPENDIX A ~ 411
The committee recommends that the CDC AIDS program increase
its staff of persons knowledgeable about survey sampling and sur-
vey design, and that it exploit the methodological expertise of the
National Center for Health Statistics.
The committee recommends that, in addition to experienced survey
scientists, CDC obtain technical assistance to evaluate intervention
programs it is currently funding.
The committee recommencis the use of PHS fellowship programs
and Intergovernmental Personnel Appointments (IPAs) as an in-
terim means for rapidly enlarging the cadre of senior behavioral and
social scientists working on AIDS programs at CDC and other PHS
agencies.
Representative terms from entire chapter:
drug users
